International Urology and Nephrology

, Volume 51, Issue 4, pp 723–727 | Cite as

ISPD guideline-driven retraining, exit site care and decreased peritonitis: a single-center experience in Israel

  • Yael EinbinderEmail author
  • Keren Cohen-Hagai
  • Pnina Shitrit
  • Tali Zitman-Gal
  • Daniel Erez
  • Sydney Benchetrit
  • Ze’ev Korzets
  • Andy Kotliroff
Nephrology - Original Paper



Evaluate the efficacy of retraining and catheter exit site care in reducing peritonitis rates.


This interventional study included all prevalent PD patients from 1/2009 to 12/2017 from a single center. Peritonitis rates and causative organisms were assessed and compared in three periods: (1) Before intervention (01/2009–12/2014), (2) after educational intervention: assessment of training process by infection control nurse and repeat training every 3 months, after each peritonitis episode and after hospitalizations > 2 weeks (01/2015–02/2016), and (3) in addition to the measures in period 2, an exit site care protocol including postoperative care, topical antibacterial therapy and nasal Staph aureus screening and eradication was implemented (03/2016–12/2017).


The study included 201 patients (149 men, 52 women), mean age was 65.1 ± 12.6 years. After both interventions, including educational and exit site care strategies, peritonitis decreased significantly from 1.05 episodes per patient-year (n = 113) to 0.67 (n = 54); P = 0.017 between periods 1 and 3. The percentage of peritonitis-free patients increased from 27.4 to 52.4 and 55.6%, respectively (P = 0.001 between period 1 vs. 2 and period 1 vs. 3.). Coagulase-negative staph was the most common pathogen, causing 7.56 peritonitis episodes per year, followed by pseudomonas at 4.33 episodes annually and staph aureus at 3.44 episodes per year.


Enforcement of an educational program and strict adherence to an exit site care protocol was associated with a significant decrease in peritonitis rates.


Peritonitis Peritoneal dialysis Exit site care Education and training 


Compliance with ethical standards

Conflict of interest

No conflict exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Nephrology and HypertensionMeir Medical CenterKfar SabaIsrael
  2. 2.Infection Control UnitMeir Medical CenterKfar SabaIsrael
  3. 3.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

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